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C1-1 U BB6 <br /> <br /> <br />ISSUING COMPANY <br />ACE AMERICAN INSURANCE COMPANY <br />NCCI CARRIER CODE <br />12165 <br />EXTENSION OF INFORMATION <br />PAGE-CLASSIFICATION <br />POLICY NUMBER New X Renewal Rewrite <br />Symbol: WLR Number: C6 60 38 62 2 <br />ri Individual 1-1 Partnership PREVIOUS POLICY NO. <br />Symbol: WLR Number: C65224987 E Corporation El <br />CALIFORNIA <br />Complete Item 4. of the Information Page <br />Classifications Code <br />No. <br />Premium Basis Rate Estimated <br />Premium Estimated Total <br />Remuneration _ <br />Per $100 of <br />Remuneration <br />AEGION CORP <br />CLERICAL OFFICE EMPLOYEES NOC 8810 .28 <br />BRINDERSON <br />OIL OR GAS REFINING, DISTILLING OR COMMPRESSING *3719 1.64 <br />UNITS - ERECTION OR REPAIR - ALL OPERATIONS <br />MILLWRIGHT WORK NOC 3724 4.01 <br />PLUMBING - LOW WAGE 5183 5.63 <br />PLUMBING-HIGH WAGE 5187 3.38 <br />CONCRETE CONSTRUCTION NOC - INCL. FOUNDATIONS 5213 5.89 <br />CONTRACTOR - EXECUTIVE SUPERVISOR 5606 .72 <br />ENGINEERS - INCLUDING OUTSIDE SALESPERSONS AND 8601 .29 <br />CLERICAL OFFICE EMPLOYEES <br />SALESPERSONS - OUTSIDE 8742 .36 <br />CLERICAL OFFICE EMPLOYEES NOC 8810 .28 <br />CORRPRO <br />ELECTRICAL WIRING - LOW WAGE 5190 4.53 <br />CONTRACTOR - EXECUTIVE SUPERVISOR 5606 .72 <br />DRILLING - NOT GEOTHERMAL, OIL OR GAS, MINING, 6204 9.65 <br />QUARRYING <br />SALESPERSONS - OUTSIDE 8742 .36 <br />CLERICAL OFFICE EMPLOYEES NOC 8810 .28 <br />FYFE <br />ANALYTICAL OR TESTING LABORATORIES 4511 .59 <br />PAINTING - HIGH WAGE 5482 4.35 <br />CLERICAL OFFICE EMPLOYEES NOC 8810 .28 <br />ITI <br />Minimum, Estimated and Deposit Premiums are shown on the Information Page. Total State Premium <br />THIS EXTENSION OF INFORMATION PAGE IS EFFECTIVE FOR THE POLICY PERIOD INDICATED ON THE POLICY <br />INFORMATION PAGE UNLESS OTHERWISE STATED. <br />ISSUE DATE: 06/26/2019 <br /> <br />(PAGE 1 CONTINUED) <br />WC 99 04 18 (12/05) Copyright 1987 National Council on Compensation Insurance <br />INSURED COPY